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Citalopram

    Brands

    DEA Class;  Rx

    Common Brand Names; Celexa

    • Antidepressants, SSRIs

    Oral selective serotonin reuptake inhibitor (SSRI) antidepressant
    Indicated in adults for the treatment of depression; no approved uses in pediatric patients
    Known risk of QT prolongation; increased risk of suicidality during the initial stages of treatment in pediatric and young adult patients

    Depression in patients whose diagnosis corresponds most closely to the DSM-III and DSM-III-R category of major depressive disorder

    For the treatment of major depression.
    For the treatment of social phobia (social anxiety disorder).
    For the treatment of obsessive-compulsive disorder (OCD).
    For the treatment of panic disorder (with or without agoraphobia).
    For the treatment of posttraumatic stress disorder (PTSD).
    For the treatment of hot flashes in women experiencing symptoms of menopause.

    Hypersensitivity

    Coadministration with pimozide

    • Dry mouth (20%)
    • Nausea (21%)
    • Somnolence (18%)
    • Insomnia (15%)
    • Xerostomia (20%)
    • Increased sweating (11%)
    • Tremor (8%)
    • Diarrhea (8%)
    • Ejaculation disorder (6%)
    • Rhinitis (5%)
    • Upper respiratory infection (5%)
    • Dyspepsia (5%)
    • Fatigue (5%)
    • Vomiting (4%)
    • Anxiety (4%)
    • Anorexia (4%)
    • Abdominal pain (3%)
    • Agitation (3%)
    • Impotence (3%)
    • Sinusitis (3%)
    • Dysmenorrhea (3%)
    • Decreased libido (2%)
    • Yawning (2%)
    • Arthralgia (2%)
    • Myalgia (2%)
    • Amenorrhea (>1%)
    • Confusion (>1%)
    • Cough (>1%)
    • Flatulence (>1%)
    • Increased saliva (>1%)
    • Migraine (>1%)
    • Orthostatic hypotension (>1%)
    • Paresthesia (>1%)
    • Polyuria (>1%)
    • Pruritus (>1%)
    • Rash (>1%)
    • Tachycardia (>1%)
    • Weight change (>1%)

    Pregnancy: Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn, or PPHN (see Pregnancy)

    Neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

    Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years)

    Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

    Risk of hyponatremia, abnormal bleeding (increased if concomitant aspirin, NSAIDs, or anticoagulants, or hemorrhagic diathesis), and impairment of cognitive and motor functions

    Risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions have been reported with SSRIs alone or with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin, or with antipsychotics or other dopamine antagonists

    Activation of mania/hypomania has been reported; use caution when treating patients with history of mania

    Increased risk of bone fractures reported with antidepressant use; use caution; consider possibility of fracture it patient presents with bone pain

    May cause or exacerbate sexual dysfunction

    Use caution when treating patients with history of seizure disorder

    Rare cases of hyponatremia and development of SIADH reported with either SSRI or SNRI use

    Consider risk of serotonin syndrome if administered concomitantly with other serotonergic drugs including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort

    Not recommended in patients with uncompensated heart failure

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy

    There are reports of breastfed infants exposed to this drug experiencing irritability, restlessness, excessive somnolence, decreased feeding, and weight loss

    Adults

    60 years and younger: 40 mg/day PO in the general population and 20 mg/day PO in poor metabolizers of CYP2C19.
    Older than 60 years: 20 mg/day PO.

    Geriatric

    20 mg/day PO.

    Adolescents

    Safety and efficacy have not been established; however, doses up to 40 mg/day PO have been used off-label for depression and anxiety disorders. Do not exceed 20 mg/day PO in poor metabolizers of CYP2C19.

    Children

    6 to 12 years: Safety and efficacy have not been established; however, doses up to 40 mg/day PO have been used off-label for depression and anxiety disorders. Do not exceed 20 mg/day PO in poor metabolizers of CYP2C19.
    1 to 5 years: Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Citalopram hydrobromide

    tablet

    • 10mg
    • 20mg
    • 40mg

    oral solution

    • 10mg/5mL